PresbyMAX is usually not suitable when corneal topography is abnormal, especially if there are signs of ectasia or significant irregularity.
Why abnormal topography is a concern
It increases risk and reduces predictability.
- Irregular maps may indicate early keratoconus or biomechanical weakness
- Laser ablation on an unstable cornea can worsen shape and vision
- Multifocal profiles require a regular surface for good quality vision
- Higher chance of glare, ghosting, and reduced contrast afterwards
- Standard refractive guidelines treat suspicious topography as a major red flag
Alternative approaches
Safer options are preferred.
- Rigid or scleral contact lenses to regularise optics
- Corneal cross‑linking where progressive ectasia is present
- Lens‑based presbyopia solutions if internal optics are suitable
- Use of reading glasses or multifocal contacts for near work
- Management under a corneal specialist rather than proceeding with laser
